Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru.

BACKGROUND: The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients initiating dialysis and overall mortality. A previous study found that adherent patients have 58% protection against progression to dialysis compared to non-adherent. The main objective of the study was to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. METHODS: We use a Markov model of three health stages to simulate disease progression among chronic kidney disease patients in Lima, Peru. The simulation time-horizon was 30 years to capture the lifetime cost and health consequences comparing the RHP to usual care. Costs were estimated from the payer perspective using institutional data. Health outcomes included years lived free of dialysis (YL) and quality adjusted life years (QALY). We conducted a probabilistic sensitivity analysis (PSA) to assess the robustness of our estimates against parameter uncertainty. RESULTS: We found that the RHP was dominant-cost-saving and more effective-compared to usual care. The RHP was 783USD cheaper than the standard of care and created 0.04 additional QALYs, per person. The Incremental Cost-Effectiveness Ratio (ICER) showed a cost per QALY gained of $21,660USD. In the PSA the RHP was dominant in 996 out of 1000 evaluated scenarios. CONCLUSIONS: The RHP was cheaper than the standard of care and more effective due to a reduction in the incidence of patients progressing to dialysis, which is a very expensive treatment and many times inaccessible. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of clinical-management-based prevention strategies for CKD patients.

Natural vertical transmission of dengue viruses by Aedes aegypti in Bolivia.

The natural transmission of dengue virus from an infected female mosquito to its progeny, namely the vertical transmission, was researched in wild caught Aedes aegypti during an important outbreak in the town of Santa Cruz de la Sierra, Bolivia. Mosquitoes were collected at the preimaginal stages (eggs, larvae and pupae) then reared up to adult stage for viral detection using molecular methods. Dengue virus serotypes 1 and 3 were found to be co-circulating with significant higher prevalence in male than in female mosquitoes. Of the 97 pools of Ae. aegypti (n = 635 male and 748 female specimens) screened, 14 pools, collected in February-May in 2007, were found positive for dengue virus infection: five DEN-1 and nine DEN-3. The average true infection rate (TIR) and minimum infection rate (MIR) were respectively 1.08% and 1.01%. These observations suggest that vertical transmission of dengue virus may be detected in vectors at the peak of an outbreak as well as several months before an epidemic occurs in human population.

Epidemiological analysis of the influenza A(H1N1)v outbreak in Bolivia, May-August 2009.

The outbreak of pandemic influenza (H1N1) began in Bolivia on 25 May 2009. Between May and August, the National Center of Tropical Disease (CENETROP) analysed by RT-PCR 7,060 samples of which 12.7% were positive. A preliminary analysis of the 895 confirmed cases identified between May and August 2009 describes epidemiological and clinical characteristics. After the first imported cases from the United States and Peru, the locally acquired infections predominated (90%). The number of cases was highest in the age group of 10 to 29 year-olds, and 89.6% of cases were observed in people under the age of 40 years. Fever, cough, nasal discharge and headache remained the main symptoms.

An epidemiological study of Taenia solium cysticercosis in a rural population in the Bolivian Chaco.

A survey of 100 rural households in a village in the Chaco region of Bolivia revealed a serious problem of Taenia solium cysticercosis, with a seroprevalence of 99/447 (22%) in humans and 102/273 (37%) in pigs. Risk factors for humans were being in older age groups, absence of sanitary facilities, poor formal education and inability to recognise infected pork. Significant risk indicators were a history of seizures and the reported elimination of worms in the faeces. Risk factors for pigs were being in older age groups and absence of sanitary facilities in the owner's house. The proportion of households with evidence of human cysticercosis was similar for those who owned pigs (48%) and those that did not (55%). This unexpected finding was attributed to the high overall prevalence of cysticercosis in pigs and the probability that everyone, regardless of pig-ownership, had ample opportunity to become infected in such communities. The main recommendation for reducing the prevalence of human cysticercosis was to provide more effective education campaigns, aimed at preventing both T. solium infection and cysticercosis.

Prevalencia de infeccion chagasica entre empleados activos de una empresa de servicios publicos, en Santa Cruz de la Sierra-Bolivia / Prevalencia of infection chagasica among active amployees of a company of public services, in Santa Cruz of the Sierra - Bolivia

Por medio de una encuesta sero-electrocardiografica para la enfermedad de chagas entre trabajadores de una empresa de servicios publicos de la ciudad de Santa Cruz, se reporta una prevalencia de infeccion chagasica del 25.8 por ciento (IC 95 por ciento de 22.0-29.8 por ciento). Una prevalencia de anormalidades electrocardiograficas del 13.3 por ciento (IC 95 por ciento de 7.9-20.4 por ciento). La anormalidad electrocardiografica mas frecuente fue el bloqueo de la rama derecha asociado al hemibloqueo anterior que se constituyo en el 35.3 por ciento de las anormalidades observadas, no se observo diferencia en la proporcion de infectados por el T. cruzi en relacion al lugar de nacimiento. De las 128 personas con serología positiva para la enfermedad de chagas 35 (27.3 por ciento) (IC 95 por ciento de 19.8-35.9 por ciento) habian donado sangre alguna vez en su vida

Prevalencia de infeccion chagasica en embarazadas en la maternidad Percy Boland, Santa Cruz, Bolivia / Prevalencia of infections chagasica in pregnant of the Meternidad Percy Boland in Santa Cruz - Bolivia

Se reportan los resultados de una encuesta serologica sobre la infeccion por el T. cruzi realizada en mujeres gestantes que asistieron a su control pre-natal al Instituto Maternologico Percy Boland de la ciudad de Santa Cruz de la Sierra durante el año 1996. De un total de 619 muestras analizadas se obtuvo resultados positivo en 190 (30,67 por ciento IC. 27.1 por ciento 34.5 por ciento. Se concluye que la prevalencia de infeccion chagasica en embarazadas de la Maternidad Percy Boland es elevada